VOL: 98, ISSUE: 23, PAGE NO: 53
Ellie Clarke, RN, is a community nurse at Field House Medical Centre, Grimsby; Anne Martin, RN, is a staff nurse at Diana, Princess of Wales Hospital, GrimsbyIn recent months, hospital acquired infection (HAI) has been the subject of a great deal of media coverage, largely due to the fact that HAIs result in 5,000 deaths a year. It is also accepted that many HAIs could be prevented by the use of appropriate infection control practices.
In recent months, hospital acquired infection (HAI) has been the subject of a great deal of media coverage, largely due to the fact that HAIs result in 5,000 deaths a year. It is also accepted that many HAIs could be prevented by the use of appropriate infection control practices.
A number of government-sanctioned initiatives are being introduced to help reduce the incidence of HAI, including one to raise the standards of cleanliness in hospitals (Gunning 2000), and another to develop a controls assurance standard in infection control (NHS Executive, 1999).
Poor compliance with hand-washing practice among health care professionals is recognised as a significant factor in the development of HAI (Gould, 1991). Lack of education on the principles of infection control may also be a contributing factor. One way to improve these standards of practice could be through computer-assisted learning (CAL) programs.
This article reports on our experiences in using such a program while studying for a pre-registration nursing diploma. It significantly increased our knowledge of infection control, and we believe that it may be helpful for use with other students, in order to give them a sound knowledge base before they go on to clinical placements.
What is computer-assisted learning?
The use of computers to deliver nurse education is increasing (Halloran, 1995). According to Nerlich (1995), this method of delivery presents users with an interface (constructed by an educator who is skilled in the particular field of study) that allows them to follow a lesson plan or gives them self-directed access to particular information. It has been described as a unique learning resource that offers self-developed learning, time savings and cost-effectiveness (Blitzer and Boudreaux, 1969; Hassett, 1986).
While studying on a preregistration diploma course in nursing at Hull University we went on clinical placement at Diana, Princess of Wales Hospital, Grimsby. During the placement we asked the infection control nurse if we could spend a day learning about her role, as we felt it would be beneficial to our knowledge and practice, as well as fostering our understanding of microbiology and infection control. The day included a visit to the pathology laboratory, where we were shown how micro-organisms are identified. This whetted our appetite for more knowledge and understanding of microbiology.
At the time of the placement, a pilot study was under way within the trust, evaluating the use of a CAL program (edhitec Health Systems IC2000) to teach qualified nurses about infection control (Duncanson, 1999). When the infection control nurse told us about the study, we decided to try the CAL program ourselves, as we felt it would not only enhance our knowledge of infection control but would also build on the theory and information technology skills we had acquired in our diploma programme.
Before undertaking the CAL, we informed the appropriate nurse tutor and gained her approval. The infection control nurse supported us in using the package, and we were given a diary in which to record our progress, thoughts and feelings about CAL.
In order to determine our existing knowledge and awareness of infection control, we answered a set of multiple-choice questions on the program's assessment module. These were on subjects covered in the programme, and included the following:
- Body defence mechanisms;
- Basic microbiology;
- Safe environment;
- Staff health;
- Safe practice;
- Specific diseases.
We undertook the CAL over a seven-month period, and our supernumerary status meant that we were able to spend up to two hours a week on it while on clinical placement. Our ward-based clinical assessors agreed that this was time well spent, as it added value to our practical experience.
Table 1 shows the pre- and post-training assessment results we achieved together. We should mention here that, having worked as health care assistants before starting our diploma training, we both had a basic understanding of infection control. However, in each subject area our knowledge had increased significantly after using the CAL program, showing that it had been an effective learning tool for us.
Advantages and disadvantages of CAL
We found a number of advantages to using this approach to learning about infection control - not least that it made the subject more interesting than any education we had experienced previously. Students can explore the program at their own pace, and can identify and work on areas of weakness in their knowledge.
The program includes a selection of case studies, which suggest the topics students need to cover in order to care for patients with specific infections. These include scenarios in a range of health care environments, which enable students to make links with areas in which they have been on clinical placement.
There were no real disadvantages to using the CAL in itself - the only problem we found was trying to fit it into the rest of our studies. Members of staff in the placement areas were extremely supportive in enabling us to take the time out to do this program. However, we feel it would be helpful if the CAL were integrated into the diploma programme, so that dedicated time could be allocated to it.
The CAL has enabled us to develop a knowledge base in infection control, helped us to identify weaknesses in our own practice and allowed us to explore ways in which to improve through self-directed learning. The program uses evidence-based practice, which we can now use to educate others (patients, visitors and other staff members) in infection control procedures.
We feel that we are now more aware of the causes of infection and can identify poor practice in the hospital environment.
We believe that this CAL program would be beneficial if it were incorporated into preregistration nurse education. We reported our experiences of it to our nursing tutor, who was interested in the package and asked for more information.
It is easy for students to pick up 'bad habits' (poor practice) in infection control, particularly early on in their training when they spend time observing other health care professionals, as not all comply with infection control procedures. For example, according to Desai et al (1997), compliance with infection control procedures by medical staff ranges from 30-70%, and new staff may not be familiar with local procedures. Once developed, these bad habits can be difficult to break.
The CAL program highlighted the fact that we ourselves had picked up poor practices during our nurse training, but having them identified at an early stage will hopefully enable us to correct them.
Giving students a knowledge base on infection control at the start of their nurse education programme may enable them to practise good standards of infection control throughout their education.
Once qualified, these students will act as mentors/assessors and pass on their skills and knowledge to future students. Computer-assisted learning may, therefore, help to reduce the incidence of hospital-acquired infections in the future.